[Non-aneurysmal subarachnoid haemorrhage secondary to panarteritis nodosa at paediatric age: a case report]. / Hemorragia subaracnoidea no aneurismatica secundaria a panarteritis nodosa en edad pediatrica: caso clinico.

INTRODUCTION: Polyarteritis nodosa is a necrotizing vasculitis that mainly affects small and medium-sized arteries in skin and internal organs. Neurological involvement is reported in around 25% of cases: ischemic stroke is relatively common, but haemorrhagic lesions are extremely rare. Subarachnoid haemorrhage in polyarteritis nodosa is an uncommon expression of this disease, mostly associated with aneurism rupture. To the best of the authors' knowledge, there is just one published case in pediatric age with polyarteritis nodosa and subarachnoid haemorrhage with no underlying aneurismal disease. CASE REPORT: A 7-year-old girl, who presented a non-aneurismal subarachnoid haemorrhage with intraparenchymal extension in the left basal ganglia. She was previously diagnosed with polyarteritis nodosa and prothrombotic condition, being under immunosuppressive and anti-platelet treatment at that moment. CONCLUSIONS: The clinical features of polyarteritis nodosa together with continued anti-platelet therapy to prevent thromboembolic disease in this patient could have predisposed to the haemorrhagic event in the process of cerebral vasculitis. Standard subarachnoid haemorrhage management is initially required in such cases as cerebral aneurysms are the most common cause of haemorrhage in the context of polyarteritis nodosa disease.

TITLE: Hemorragia subaracnoidea no aneurismatica secundaria a panarteritis nodosa en edad pediatrica: caso clinico.Introduccion. La panarteritis nodosa es una vasculitis necrotizante que afecta de manera predominante a arterias de pequeño y mediano calibre de la piel y los organos internos. La afectacion neurologica sucede en un 25% de casos: los ictus isquemicos son relativamente frecuentes, pero las lesiones hemorragicas resultan extremadamente raras. La hemorragia subaracnoidea es una expresion poco comun de la enfermedad, asociada la inmensa mayoria de las veces a patologia aneurismatica. En nuestro conocimiento, solo existe otro caso descrito de panarteritis nodosa con hemorragia subaracnoidea en la edad pediatrica sin patologia aneurismatica subyacente. Caso clinico. Niña de 7 años que presento una hemorragia subaracnoidea no aneurismatica con extension intraparenquimatosa a los ganglios basales izquierdos. Previamente se habia diagnosticado panarteritis nodosa y enfermedad protrombotica, en tratamiento con farmacos inmunodepresores y antiagregantes en ese momento. Conclusiones. Las caracteristicas clinicas de la panarteritis nodosa, junto con el tratamiento antiagregante para prevenir la enfermedad tromboembolica en nuestra paciente, podrian haber predispuesto al evento hemorragico en el proceso de la vasculitis cerebral. El manejo estandar de la hemorragia subaracnoidea es necesario en estos casos debido a que los aneurismas cerebrales son la causa mas comun de hemorragia subaracnoidea en un contexto de panarteritis nodosa.

Seguimiento mediante técnicas de neuroimagen de los aneurismas cerebrales tratados por vía endovascular / Neuroimaging follow-up of cerebral aneurysms treated with endovascular techniques

No existen recomendaciones específicas en las guías de práctica clínica sobre el tiempo, prueba de imagen ni intervalo para controlar la evolución de los aneurismas intracraneales tratados por vía endovascular. Hemos revisado la bibliografía existente en las principales bases de datos médicas usando como palabras clave: aneurisma cerebral, espirales, procedimiento endovascular y seguimiento. Nuestro objetivo ha sido, dentro del Grupo de Enfermedades Cerebrovasculares de la Sociedad Española de Neurorradiología, proponer unas recomendaciones y un protocolo orientativo, basados en la evidencia científica, para monitorizar mediante neuroimagen los aneurismas intracraneales tratados por técnicas endovasculares, incluyendo las técnicas de neuroimagen más adecuadas, el intervalo, el tiempo de seguimiento y la mejor forma de definir los hallazgos radiológicos, con el objetivo de mejorar los resultados clínicos y optimizar y racionalizar los recursos disponibles (AU)

There are no specific recommendations in clinical guidelines about the best time, imaging tests, or intervals for following up patients with intracranial aneurysms treated with endovascular techniques. We reviewed the literature, using the following keywords to search in the main medical databases: cerebral aneurysm, coils, endovascular procedure, and follow-up. Within the Cerebrovascular Disease Group of the Spanish Society of Neuroradiology, we aimed to propose recommendations and an orientative protocol based on the scientific evidence for using neuroimaging to monitor intracranial aneurysms that have been treated with endovascular techniques. We aimed to specify the most appropriate neuroimaging techniques, the interval, the time of follow-up, and the best approach to defining the imaging findings, with the ultimate goal of improving clinical outcomes while optimizing and rationalizing the use of available resources (AU)

[Neuroimaging follow-up of cerebral aneurysms treated with endovascular techniques]. / Seguimiento mediante técnicas de neuroimagen de los aneurismas cerebrales tratados por vía endovascular.

There are no specific recommendations in clinical guidelines about the best time, imaging tests, or intervals for following up patients with intracranial aneurysms treated with endovascular techniques. We reviewed the literature, using the following keywords to search in the main medical databases: cerebral aneurysm, coils, endovascular procedure, and follow-up. Within the Cerebrovascular Disease Group of the Spanish Society of Neuroradiology, we aimed to propose recommendations and an orientative protocol based on the scientific evidence for using neuroimaging to monitor intracranial aneurysms that have been treated with endovascular techniques. We aimed to specify the most appropriate neuroimaging techniques, the interval, the time of follow-up, and the best approach to defining the imaging findings, with the ultimate goal of improving clinical outcomes while optimizing and rationalizing the use of available resources.

Early Experience Studying Cerebral Aneurysms with Rotational and Threedimensional Angiography and Review of CT and MR Angiography Literature.

SUMMARY: From september 2000 to september 2001, 32 consecutive patients with ruptured intracranial aneurysms were examined with rotational and 3D reconstruction angiography using an Integris V5000 Philips Medical System: 39 aneurysms were detected. After a selective cerebral artery was catheterized with a 5F or 4F-catheter, 35 ml of contrast medium was intra-arterially administered at a rate of 4 ml/s and a 180 degrees rotational angiography was performed in eight seconds. This information was transferred to a computer (Silicon Graphics Octane) with software (Integris 3DRA, Philips Integris Systems) and a three-dimensional reconstruction was made. The information provided by Angio-3D was useful for evaluating the parent artery, aneurysmal sac, aneurysmal neck and arterial branches. It was also very useful in selecting the therapeutic method. For open surgery, this technique provides preoperative images that are useful for planning microsurgical approaches, especially in cases of large aneurysm showing complex surrounding arteries. For endovascular embolization, various anatomic characteristics of the aneurysm such as neck and sac size, shape, lobularity, parent artery and arterial branches adjacent to the aneurysmal neck must be demonstrated. This is very important to determine the best projection for embolization and to avoid multiple series. This is also essential in the choice of the first coil to create a good basket producing total occlusion. Microaneurysms are demonstrated well with this technique whereas this is difficult to do with conventional arteriography. The Angio-RM and Angio-CT literature show a lower sensitivity and specificity in comparasion with our experience with 3D IA-ROT-DSA. For this reason, we believe that 3D IA-ROTDSA is now the gold standard for patients presenting intracranial aneurysms.